Life Extension Magazine®

Older couple on a run who have enhanced plaque stability

Protect Against Occlusive Arterial Plaque

Two plant extracts have been shown to inhibit atherosclerosis and to reduce unstable plaque. In one controlled study, the extract blend led to an 82% reduction in major cardiovascular events, including heart attack and stroke.

Scientifically reviewed by: Gary Gonzalez, MD. Written by: Michael Downey.

Atherosclerosis can lead to heart attacks and strokes…the top causes of death worldwide.1

Two plant extracts have been shown to inhibit the development and worsening of atherosclerosis and to reduce unstable plaque, the most dangerous form.

Placebo controlled clinical studies reveal that when these extracts are combined, they work better than separately.

In one study, participants taking the two extracts experienced 95% less progression of plaque, compared to a control group receiving standard care,2 and in another study, the extract blend led to an 82% reduction in major cardiovascular events, including heart attack and stroke.3

Arterial Plaque

Atherosclerosis is a chronic, inflammatory vascular disease that involves plaque buildup on the inner walls of arteries, narrowing the opening and making the arteries stiff and inflexible.4

These plaques can be unstable and rupture.5

Atherosclerosis initiates and progresses for decades before symptoms develop.4,5 Conventional  risk factors include:6

  • Aging,
  • Family history of cardiovascular disease,
  • Abnormal lipid levels, including elevated LDL ("bad") cholesterol, high triglycerides, and low HDL ("good") cholesterol,
  • High blood pressure,
  • Elevated blood sugar,
  • Obesity and sedentary lifestyle,
  • Poor diet, and
  • Smoking.

The process of plaque formation involves inflammation, necrosis, fibrosis, and calcification.7

When atherosclerotic plaques rupture, or when a blood clot (thrombus) forms on jagged plaque, the result can be catastrophic arterial occlusions. These blockages, either partial or complete, can cause a heart attack or an ischemic stroke.8

Two plant extracts have been shown to inhibit atherosclerosis: Centella asiatica and French maritime pine bark.

Centella Asiatica

Centella asiatica (also known as gotu kola) is a plant native to Asia. It has long been used in traditional medicine for various disorders and wound treatment.9

Centella contains compounds called triterpenes, which are believed to inhibit plaque by their anti-inflammatory activity.10 Triterpenes also stabilize more dangerous soft plaque by improving the synthesis of collagen,10-13 which holds soft plaque in place.11,14,15

Centella also reduces the adhesion of monocytes, immune cells that promote atherosclerosis.15,16

In a clinical study of patients with soft plaque, taking 60 mg of Centella asiatica extract three times daily for 12 months resulted in no increase in plaque size, compared to a 23% increase in a placebo group.11

The extract also produced a 63% more firm plaque, which is associated with less rupture risk.11

Pine Bark

French maritime pine bark contains compounds known as procyanidins and phenolic acids.17,18

In multiple clinical studies, these compounds have been shown to slow atherosclerosis progression,18  an effect that may result, in part, from reduced expression of inflammatory signaling molecules that contribute to plaque formation.19,20

In a clinical study of patients with coronary artery disease, those taking 200 mg of French maritime pine bark extract daily for 8 weeks had increased flow-mediated dilation (a measure of beneficial arterial widening) by 32%. There were no significant changes in the placebo group.21

What You Need to Know

Reduce Heart Attack and Stroke Risk

  • Atherosclerosis, plaque in the arteries, frequently leads to strokes or heart attacks. It is the leading cause of death worldwide.
  • Extracts of French maritime pine bark and Centella asiatica safely target this dangerous condition.
  • Clinical studies show that, taken together, these extracts slow, and even reverse plaque accumulation, while boosting the stability of dangerous soft plaque to help prevent a deadly rupture.
  • In a clinical study, this dual extract blend led to 7.4 times lower progression of the disease.

Combined Effects

The effects of these extracts were even more impressive when they were combined.

In one clinical study, individuals aged 45 to 60 whose plaques were a relatively mild class IV all received diet and lifestyle counseling. Participants were also randomized into six groups to receive either:

  • Lifestyle counseling,
  • Lifestyle counseling plus 100 mg of aspirin,
  • Lifestyle counseling plus 50 mg of standardized French maritime pine bark,
  • Lifestyle counseling plus 100 mg of standardized French maritime pine bark,
  • Lifestyle counseling plus 100 mg standardized French maritime pine bark with 100 mg aspirin, or
  • Lifestyle counseling plus 100 mg of French maritime pine bark extract with 100 mg of Centella asiatica extract.

The percentage of plaques that worsened to class V, blocking more than 50% of an artery, was:2

  • 21.3% in those receiving only lifestyle and diet counseling, but only
  • 1.1% in those receiving the dual extracts (pine bark + Centella asiatica).

Scientists gave the same dosages to a group of patients with class V plaques (more than 50% blockage of at least one major artery). After 42 months, the percentage of subjects whose plaques progressed to class VI, which involves symptoms such as numbness, tingling, or chest pain, was:22

  • 48.0% in those who received lifestyle counseling only, and
  • 6.5% in subjects receiving pine bark and Centella asiatica.

The extract blend led to 7.4 times lower progression of the disease over the study period of 42 months. In addition, cardiovascular events (hospitalization, chest pain, heart attack, or stroke) occurred in 4.4% of the combination extract group, as compared to 16% in the standard care group.22

Additional Clinical Validation

In two more clinical trials, scientists used a combination of 150 mg of French maritime pine bark extract and 450 mg of Centella asiatica extract daily, along with 100 mg of aspirin, which is often recommended for those with atherosclerosis.3,23

In one of these studies, patients with atherosclerotic plaque were monitored for three years. All subjects received standard diet, lifestyle, and exercise counseling. A control group received no additional treatment, a second group was given only aspirin, and a third received aspirin plus the dual-extract blend.3

Plaque progression was observed in 5.3% of those in the dual-extract group, but it was found in over 20% of the two groups that did not receive the extracts. Major cardiovascular events (such as heart attack or stroke requiring hospitalization), occurred in:3

  • 22% of the control group, but
  • Less than 4% of those taking the extracts and aspirin.

Another study investigated calcification of coronary arteries. Participants were randomized into three groups to receive either:

  • Standard counseling and 100 mg of aspirin daily
  • Standard counseling with 150 mg of French pine bark extract, or
  • Standard counseling with 150 mg of French pine bark and 450 mg of Centella extract daily23

After 12 months, the number of calcifications:23

  • Increased by 35% in those with counseling and aspirin, but
  • Decreased by 10% in those taking 150 mg of French pine bark and 450 mg of Centella extract.

Enhanced Plaque Stability

Some plaques are worse than others.

In a six-month clinical study of patients with atherosclerotic plaques, mild hypertension, and elevated cholesterol, subjects were divided into a lifestyle counseling group, a group that received the two herbal extracts, and a group that received both. Ultrasound imaging was used to assess plaque stability.24

In patients receiving only lifestyle counseling, plaque stability did not change significantly over six months.

But in patients receiving 150 mg of French maritime pine bark extract and 450 mg of Centella asiatica extract daily, the plaque stability index doubled. This means their plaques were less likely to rupture and induce catastrophic clotting.24

Plaque size and number also decreased significantly in treated individuals.


Plaque accumulation in arteries is the signature characteristic of atherosclerosis, the underlying cause of most heart attacks and strokes.

Scientists have identified two plant extracts that target atherosclerosis and its consequences.

A blend of French maritime pine bark and Centella asiatica extracts has been shown to slow plaque growth, while boosting stability of deadly soft plaque, to help prevent a rupture.

This dual extract blend reduced progression of arterial plaque by as much as 95% in a clinical study.

When used together, these extracts have been shown to help slow the development and progression of atherosclerosis, when combined with therapeutic lifestyle modification.

If you have any questions on the scientific content of this article, please call a Life Extension Wellness Specialist at 1-866-864-3027.


  1. Fan J, Watanabe T. Atherosclerosis: Known and unknown. Pathol Int. 2022Mar;72(3):151-60.
  2. Belcaro G, Dugall M, Hosoi M, et al. Pycnogenol(R) and Centella Asiatica for asymptomatic atherosclerosis progression. Int Angiol.2014Feb;33(1):20-6.
  3. Belcaro G, Cesarone MR, Scipione C, et al. Delayed progression of atherosclerosis and cardiovascular events in asymptomatic patients with atherosclerotic plaques: 3-year prevention with the supplementation with Pycnogenol(R)+Centellicum(R). Minerva Cardioangiol.2020Feb;68(1):15-21.
  4. Otsuka F, Yasuda S, Noguchi T, et al. Pathology of coronary atherosclerosis and thrombosis. Cardiovasc Diagn Ther.2016Aug;6(4):396-408.
  5. Wohlschlaeger J, Bertram S, Theegarten D, et al. [Coronary atherosclerosis and progression to unstable plaques : Histomorphological and molecular aspects]. Herz.2015Sep;40(6):837-44.
  6. Available at: . Accessed 06/12/2023,
  7. Shi X, Gao J, Lv Q, et al. Calcification in Atherosclerotic Plaque Vulnerability: Friend or Foe? Front Physiol.2020;11:56.
  8. Available at: . Accessed 06/12/2023,
  9. Gohil KJ, Patel JA, Gajjar AK. Pharmacological Review on Centella asiatica: A Potential Herbal Cure-all. Indian J Pharm Sci.2010Sep;72(5):546-56.
  10. Sun B, Wu L, Wu Y, et al. Therapeutic Potential of Centella asiatica and Its Triterpenes: A Review. Front Pharmacol.2020;11:568032.
  11. Incandela L, Belcaro G, Nicolaides AN, et al. Modification of the echogenicity of femoral plaques after treatment with total triterpenic fraction of Centella asiatica: a prospective, randomized, placebo-controlled trial. Angiology.2001Oct;52 Suppl 2:S69-73.
  12. Incandela L, Cesarone MR, Cacchio M, et al. Total triterpenic fraction of Centella asiatica in chronic venous insufficiency and in high-perfusion microangiopathy. Angiology.2001Oct;52 Suppl 2:S9-13.
  13. Bylka W, Znajdek-Awiżeń P, Studzińska-Sroka E, et al. Centella asiatica in cosmetology. Postepy Dermatol Alergol.2013Feb;30(1):46-9.
  14. Cesarone MR, Belcaro G, Nicolaides AN, et al. Increase in echogenicity of echolucent carotid plaques after treatment with total triterpenic fraction of Centella asiatica: a prospective, placebo-controlled, randomized trial. Angiology.2001Oct;52 Suppl 2:S19-25.
  15. Razali NNM, Ng CT, Fong LY. Cardiovascular Protective Effects of Centella asiatica and Its Triterpenes: A Review. Planta Med.2019Nov;85(16):1203-15.
  16. Ivanov V, Ivanova S, Kalinovsky T, et al. Plant-derived micronutrients suppress monocyte adhesion to cultured human aortic endothelial cell layer by modulating its extracellular matrix composition. J Cardiovasc Pharmacol.2008Jul;52(1):55-65.
  17. D'Andrea G. Pycnogenol: a blend of procyanidins with multifaceted therapeutic applications? Fitoterapia.2010Oct;81(7):724-36.
  18. Robertson NU, Schoonees A, Brand A, et al. Pine bark (Pinus spp.) extract for treating chronic disorders. Cochrane Database Syst Rev. 2020Sep 29;9(9):Cd008294.
  19. Gu JQ, Ikuyama S, Wei P, et al. Pycnogenol, an extract from French maritime pine, suppresses Toll-like receptor 4-mediated expression of adipose differentiation-related protein in macrophages. Am J Physiol Endocrinol Metab. 2008Dec;295(6):E1390-400.
  20. Luo H, Wang J, Qiao C, et al. Pycnogenol attenuates atherosclerosis by regulating lipid metabolism through the TLR4-NF-kappaB pathway. Exp Mol Med.2015Oct 23;47(10):e191.
  21. Enseleit F, Sudano I, Periat D, et al. Effects of Pycnogenol on endothelial function in patients with stable coronary artery disease: a double-blind, randomized, placebo-controlled, cross-over study. Eur Heart J. 2012Jul;33(13):1589-97.
  22. Belcaro G, Ippolito E, Dugall M, et al. Pycnogenol(R) and Centella asiatica in the management of asymptomatic atherosclerosis progression. Int Angiol.2015Apr;34(2):150-7.
  23. Hu S, Belcaro G, Cesarone MR, et al. Central cardiovascular calcifications: supplementation with Pycnogenol(R) and Centellicum(R): variations over 12 months. Minerva Cardioangiol.2020Feb;68(1):22-6.
  24. Belcaro G, Cornelli U. Variations in Echogenicity in Carotid and Femoral Atherosclerotic Plaques with Pycnogenol + Centella Asiatica Supplementation. Int J Angiol.2017Jun;26(2):95-101.